Question: We recently hired an employee who has health coverage through the military (TRICARE). Our company provides a group major medical plan along with a health reimbursement arrangement (HRA). How will our benefits coordinate with TRICARE?
Answer: TRICARE offers several different health service and coverage programs. For active-duty servicemembers (ADSMs), TRICARE Prime is their primary and only health coverage. There are some differences in TRICARE Prime depending on where the ADSM is stationed, so personnel are advised to review their TRICARE Prime booklet and/or consult with a TRICARE coordinator for details.
Next, for dependents of ADSMs, and retired military and their dependents, any employer-sponsored health coverage is the primary coverage. That means that the employer’s group plan must pay its regular benefits without regard to any possible TRICARE coverage. It appears your new employee is a retired servicemember, so your company’s major medical plan will pay its benefits first, then any available HRA funds may be used to reimburse deductibles or out-of-pocket expenses. Finally, if the employee still has unreimbursed expenses, he may file a claim with TRICARE for possible consideration.
Note that TRICARE also is secondary to Medicare, so if the employee or dependent has both group coverage and Medicare, TRICARE will be the last in line.
Lastly, TRICARE beneficiaries are instructed to inform the TRICARE contractor of all other coverage they have by completing the “other health insurance questionnaire” posted on the TRICARE website. Since TRICARE is always the secondary payer (except from active-duty servicemembers), the TRICARE contractor will not administer claims without first having information about the individual’s other coverage sources.